Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patients.
Bedside measurement of changes in lung impedance to monitor alveolar ventilation in dependent and non-dependent parts by electrical impedance tomography during a positive end-expiratory pressure trial in mechanically ventilated intensive care unit patients.
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DOI：
10.1186/cc9036
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Gommers D
中科院分区：
文献类型：
--
作者：
Bikker IG;Leonhardt S;Reis Miranda D;Bakker J;Gommers D
由于机械通气明显会加重肺损伤，因此对呼吸机设置的个体滴定尤为重要。电阻抗断层扫描（EIT）已被提议作为床边，区域监测工具来指导这些设置。在本研究中，我们评估了在标准化呼气末正压（PEEP）试验中有或无肺部疾病的重症监护病房（ICU）患者通气分布变化图（ΔfEIT图）的使用。对14例有或无肺部疾病的ICU患者在4个PEEP水平（15 ~ 10、5 ~ 0 cm H2O）下获得功能EIT （fEIT）图像和PaO2/FiO2比值。患者采用恒压通气。从每个PEEP步骤后记录的fEIT图像中减去每次PEEP降低前的fEIT图像，以评估每个EIT像素中潮汐阻抗的区域增加/减少（ΔfEIT地图）。有无肺疾病患者的区域潮阻抗对PEEP的响应在15 ~ 10 （P = 0.002）和10 ~ 5 （P = 0.001）之间存在显著差异。在无肺疾病的患者中，当PEEP从15 cm H2O降低到10 cm H2O时，潮阻抗仅在非依赖部分增加，而在两组的其他PEEP步骤中均有所下降。在ICU患者的递减PEEP试验中，在患者的床边，仅在膈肌上方进行EIT测量，可以清楚地看到依赖部位和非依赖部位通气的改善和丧失。
As it becomes clear that mechanical ventilation can exaggerate lung injury, individual titration of ventilator settings is of special interest. Electrical impedance tomography (EIT) has been proposed as a bedside, regional monitoring tool to guide these settings. In the present study we evaluate the use of ventilation distribution change maps (ΔfEIT maps) in intensive care unit (ICU) patients with or without lung disorders during a standardized decremental positive end-expiratory pressure (PEEP) trial. Functional EIT (fEIT) images and PaO2/FiO2 ratios were obtained at four PEEP levels (15 to 10 to 5 to 0 cm H2O) in 14 ICU patients with or without lung disorders. Patients were pressure-controlled ventilated with constant driving pressure. fEIT images made before each reduction in PEEP were subtracted from those recorded after each PEEP step to evaluate regional increase/decrease in tidal impedance in each EIT pixel (ΔfEIT maps). The response of regional tidal impedance to PEEP showed a significant difference from 15 to 10 (P = 0.002) and from 10 to 5 (P = 0.001) between patients with and without lung disorders. Tidal impedance increased only in the non-dependent parts in patients without lung disorders after decreasing PEEP from 15 to 10 cm H2O, whereas it decreased at the other PEEP steps in both groups. During a decremental PEEP trial in ICU patients, EIT measurements performed just above the diaphragm clearly visualize improvement and loss of ventilation in dependent and non-dependent parts, at the bedside in the individual patient.
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影响因子：
158.5
作者：
Amato, MBP;Barbas, CSV;Carvalho, CRR
通讯作者：
Carvalho, CRR
影响因子：
38.9
作者：
Costa, Eduardo L. V.;Borges, Joao Batista;Amato, Marcelo B. P.
通讯作者：
Amato, Marcelo B. P.
影响因子：
5.7
作者：
Maisch, Stefan;Reissmann, Hajo;Bohm, Stephan H.
通讯作者：
Bohm, Stephan H.
影响因子：
9.6
作者：
Luecke, Thomas;Meinhardt, Juergen P.;Pelosi, Paolo
通讯作者：
Pelosi, Paolo
DOI：
10.1164/ajrccm.151.6.7767524
发表时间：
1995-06-01
影响因子：
24.7
作者：
GATTINONI, L;PELOSI, P;VALENZA, F
通讯作者：
VALENZA, F